Moreno R, Gordillo E, Zamorano J, Almeria C, Garcia-Rubira J C, Fernandez-Ortiz A, Macaya C
Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain.
Heart. 2003 Oct;89(10):1144-6. doi: 10.1136/heart.89.10.1144.
It is debatable whether surgical repair is routinely indicated in asymptomatic patients with left ventricular pseudoaneurysms.
To evaluate the long term outcome of patients with pseudoaneurysm after myocardial infarction, focusing on those treated conservatively.
10 patients with postinfarction left ventricular pseudoaneurysm were followed up over a mean (SD) period of 3.8 (5.2) years.
In those treated conservatively (n = 9), cumulative survival was 88.9 (10.5)% and 74.1 (16.1)% at one and four years, respectively. The probability of being free of cardiac death was 88.9 (10.5)% at both one and four years. No patient had complete fatal heart rupture during follow up. Three patients suffered ischaemic stroke (at 1, 11, and 62 months). The cumulative incidence of ischaemic stroke was 10% at one year and 32.5% at four years.
Long term outcome of patients with postinfarction left ventricular pseudoaneurysm is relatively benign, with a very low risk (none in this series) of fatal rupture. Taking into consideration the relatively high risk of stroke, chronic anticoagulant treatment could be considered.
对于无症状的左心室假性动脉瘤患者是否常规进行手术修复存在争议。
评估心肌梗死后假性动脉瘤患者的长期预后，重点关注保守治疗的患者。
对10例心肌梗死后左心室假性动脉瘤患者进行了平均（标准差）3.8（5.2）年的随访。
在保守治疗的患者（n = 9）中，1年和4年时的累积生存率分别为88.9（10.5）%和74.1（16.1）%。1年和4年时无心脏死亡的概率均为88.9（10.5）%。随访期间无患者发生完全性致命性心脏破裂。3例患者发生缺血性卒中（分别在1、11和62个月时）。缺血性卒中的累积发生率在1年时为10%，4年时为32.5%。
心肌梗死后左心室假性动脉瘤患者的长期预后相对良好，致命性破裂风险极低（本系列中无）。考虑到卒中风险相对较高，可考虑进行长期抗凝治疗。
